House Bill 4053

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    Florida House of Representatives - 1998                HB 4053

        By Representative Ziebarth






  1                      A bill to be entitled

  2         An act relating to health insurance; amending

  3         s. 627.42395, F.S.; increasing the allowable

  4         amount for certain food products covered under

  5         enteral formula insurance requirements;

  6         amending s. 641.31, F.S.; requiring health

  7         maintenance contracts or policies to provide

  8         coverage for use of enteral formulas under

  9         certain circumstances; providing application;

10         providing an effective date.

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12  Be It Enacted by the Legislature of the State of Florida:

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14         Section 1.  Section 627.42395, Florida Statutes, is

15  amended to read:

16         627.42395  Coverage for certain prescription and

17  nonprescription enteral formulas.--Notwithstanding any other

18  provision of law, any health insurance policy delivered or

19  issued for delivery, to any person in this state or any group,

20  blanket, or franchise health insurance policy delivered or

21  issued for delivery in this state shall make available to the

22  policyholder as part of the application, for an appropriate

23  additional premium, coverage for prescription and

24  nonprescription enteral formulas for home use which are

25  physician prescribed as medically necessary for the treatment

26  of inherited diseases of amino acid, organic acid,

27  carbohydrate, or fat metabolism as well as malabsorption

28  originating from congenital defects present at birth or

29  acquired during the neonatal period. Coverage for inherited

30  diseases of amino acids and organic acids shall include food

31  products modified to be low protein, in an amount not to

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CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1998                HB 4053

    559-148-98






  1  exceed $3,500 $2,500 annually for any insured individual,

  2  through the age of 24.  This section applies to any person or

  3  family notwithstanding the existence of any preexisting

  4  condition.

  5         Section 2.  Subsection (34) is added to section 641.31,

  6  Florida Statutes, to read:

  7         641.31  Health maintenance contracts.--

  8         (34)  Notwithstanding any other provision of law, each

  9  health maintenance contract or policy shall provide to the

10  subscriber coverage for prescription and nonprescription

11  enteral formulas for home use which are physician prescribed

12  as medically necessary for the treatment of inherited diseases

13  of amino acid, organic acid, carbohydrate, or fat metabolism

14  as well as malabsorption originating from congenital defects

15  present at birth or acquired during the neonatal period.

16  Coverage for inherited diseases of amino acids and organic

17  acids shall include food products modified to be low protein,

18  in an amount not to exceed $3,500 annually for any insured

19  individual, through the age of 24.  This subsection applies to

20  any person or family notwithstanding the existence of any

21  preexisting condition.

22         Section 3.  This act shall take effect upon becoming a

23  law.

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CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1998                HB 4053

    559-148-98






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  2                          HOUSE SUMMARY

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      Requires health maintenance contracts or policies to
  4    provide for use of enteral formulas necessary to treat
      inherited diseases of amino acid, organic acid,
  5    carbohydrate, or fat metabolism as well as malabsorption
      originating from congenital defects present at birth or
  6    acquired during the neonatal period. Requires such
      coverage to include up to $3,500 annually for food
  7    products modified to be low protein and applies such
      $3,500 amount to individual, group, blanket, or franchise
  8    health insurance policies. See bill for details.

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